Study: Gum Disease Shows Link to Atrial Fibrosis

Periodontitis, a gum disease that can cause many dental issues, could be associated with fibrosis, scarring to an appendage of the heart’s left atrium that can lead to an irregular heartbeat, according to the results of a study published in JACC: Clinical Electrophysiology.¹

“Periodontitis is associated with a long-standing inflammation, and inflammation plays a key role in atrial fibrosis progression and atrial fibrillation pathogenesis,” Shunsuke Miyauchi, MD, assistant professor at the Hiroshima University’s Health Service Center, said in a statement.

“We hypothesized that periodontitis exacerbates atrial fibrosis. This histological study of left atrial appendages aimed to clarify the relationship between clinical periodontitis status and degree of atrial fibrosis,” Miyauchi said.¹

The study included 76 individuals with cardiac disease. Investigators removed the left atrial appendages and analyzed the tissue to determine if there was a correlation between the severity of atrial fibrosis and the severity of gum disease.¹

All participants had oral examinations where bleeding on probing, periodontal inflamed surface area (PISA), periodontal probing depth, and remaining number of teeth were used to evaluate periodontitis.²

Investigators found that the worse the case of periodontitis, the worse the case of fibrosis, which could suggest that inflammation of the gums could intensify the inflammation and disease in the heart.¹

They found that bleeding on probing, periodontal probing depth of 4 mm or greater, and PISA correlated with atrial fibrosis. Additionally, among individuals with more than 10 teeth, PISA strongly correlated with atrial fibrosis.²

They found the same result when adjusting for age, atrial fibrosis duration, body mass index, congestive heart failure, diabetes, hypertension, mitral valve regurgitation, and previous stroke or transient ischemic attack.²

In addition to improving risk factors, such as activity level, alcohol use, tobacco use, and weight, care for periodontitis could also aid in the management of atrial fibrillation management, investigators said.¹

“Further evidence is required for establishing that periodontitis contributes to the atrial fibrosis in a causal manner and that periodontal care can alter fibrosis,” Yukiko Nakano, PhD, professor of cardiovascular medicine in Hiroshima University’s Graduate School of Biomedical and Health Sciences, said in the statement. “One of our goals is to confirm that periodontitis is a modifiable risk factor for atrial fibrillation and to promote dental specialists’ participation in comprehensive atrial fibrillation management. Periodontitis is an easy modifiable target with lower cost among known atrial fibrillation risk factors.”¹

However, the study results do not establish a causal relationship, and investigators issue caution, adding that though atrial fibrosis and gum disease appear to be connected, no definitive connection was shown.¹

Investigators hope to conduct future clinical trials to see if intervention can reduce atrial fibrillation occurrence and improve outcomes for patients.¹

References

1. Gum infection may be a risk factor for heart arrhythmia, researchers find. EurekAlert. News release. January 27, 2023. Accessed February 2, 2023. https://www.eurekalert.org/news-releases/977919

2. Miyauchi S, Nishi H, Ouhara K, Tokuyama T, et al. Relationship between periodontitis and atrial fibrosis in atrial fibrillation: histological evaluation of left atrial appendages. JACC Clin Electrophysiol. 2023;9(1):43-53. doi:10.1016/j.jacep.2022.08.018